Frailty predicts mortality after tibial plateau fracture surgery
Frailty independently predicted mortality with an adjusted odds ratio of 8.4 in 47 older adults, whereas fracture complexity and reduction quality predicted surgical failure.
The Journal of Knee Surgery
In a retrospective study of 47 patients aged 65 years and older undergoing surgery for tibial plateau fractures, researchers evaluated determinants of postoperative complications and survival. Overall mortality reached 21% across the study period and 6% within one year. Frailty independently predicted mortality (adjusted odds ratio 8.4, 95% confidence interval: 1.7–61.2) with a dose-response relationship, but it was not associated with reoperation. Instead, surgical outcomes depended on anatomy and technique. Fracture complexity independently predicted malunion (adjusted odds ratio 7.1), while both complexity (adjusted odds ratio 5.0) and non-anatomical reduction predicted reoperation. Primary total knee arthroplasty, performed in five patients permitted immediate weight-bearing, resulted in no infections, revisions, or deaths.
Why it matters
The findings show that systemic physiological reserve and local surgical variables govern distinct outcomes after trauma, highlighting frailty as a key predictor of survival in geriatric orthopedic care.
Caveats
The study is limited by its retrospective design, single-center setting, and small sample size of 47 patients, including just five who underwent primary total knee arthroplasty.
The paper
Melbourne Health · Edinburgh Royal Infirmary
The Journal of Knee Surgery · 29 Sep 2026